What are the Options in the Treatment for Acetabular Dysplasia?

In this last of a 3 part blog series, we are looking at the options in the treatment for acetabular dysplasia.  Acetabular dysplasia in the hips, also often known as developmental dysplasia refers to an underdeveloped hip socket on the pelvis, the “acetabulum”. This bony problem may in some people result in hip joint instability, early wear of the joint structures, and ultimately hip pain and osteoarthritis¹. Learning about possible treatment interventions early as key to a likely better outcome.

Want to know more? In the first blog we looked at what acetabular dysplasia actually is and the different types of dysplasia that exist.

Our second blog looked at the usual symptoms of acetabular dysplasia, where initial detection as a child may have been missed.  We also look at what may be the possible causes of this condition.

Treatment for Acetabular Dysplasia in Babies and Adults

In most countries, new born babies are routinely screened for acetabular dysplasia. A physical test is usually performed to assess for stability of the hip and if there is a concern, an ultrasound assessment may be requested. If a diagnosis of acetabular dysplasia is made, excellent results can be achieved with double nappies, braces or splints to keep the hips in a ‘frog-leg’ type position.  

This position allows the ball to push into the socket and help it mold around the ball shape of the head of the femur. Baby’s bones are still very elastic and change in shape can be achieved, which is why early diagnosis is best. 

Many adults however function very well with mild acetabular dysplasia and are not even aware they have the condition. Acetabular dysplasia may only become a problem in situations where the alteration in bony shape is more severe, or if a lot of repetitive load is placed across a dysplastic joint (e.g. long-distance running).  

If pain associated with acetabular dysplasia is diagnosed in an adult, the options depend on the age of the adult and the health of the joint. If there are already signs of hip joint osteoarthritis (cartilage wear), treatment for osteoarthritis will be offered. You can read more about osteoarthritis here.  

Possible Interventions in the Treatment for Acetabular Dysplasia? 

Treatment for pain associated with acetabular dysplasia in a young adult with no osteoarthritis, includes: 

Education

Understanding what the problem is and what types of positions and activities that are likely to irritate the hip joint, can help greatly in controlling the symptoms associated with acetabular dysplasia. 

Exercise

The other key component of a treatment plan for painful acetabular dysplasia, is a specific exercise program that includes: 

A: Stability Training

As the bony stability of the joint is reduced in acetabular dysplasia, specific exercises that target the deep cuff of muscles that hug around the hip can be useful. These muscles may help in reducing excessive translation (sliding) of the ball in the socket. Some health professionals, usually physiotherapists/physical therapists will use real-time ultrasound to assess and retrain these deep hip muscles. Ultrasound provides an excellent way to get real-time feedback on whether good activation in these muscles is being achieved. 

B: Strength Training

In addition to good deep muscle support, general strength in the larger muscles around the hip and further down the leg can be helpful in controlling larger forces that cross the joint.  For example, the large buttock, thigh and calf muscles can be very important in controlling landing forces absorbed up through the foot during walking, running and jumping. Good strength and endurance in these muscles will be important for controlling forces crossing the hip. 

C: Movement Training

The socket shape in acetabular dysplasia means that forces traveling through the hip will be absorbed over a smaller area or across a more sloping joint. In this circumstance, the direction of forces travelling across the joint is more important. The joint will be less able to control forces heading in directions where there is less than normal bony support. Particular attention to the way movement is achieved can be helpful in keeping the forces as much as possible controlled within the main bony load-bearing areas of the joint. Some early research has shown that changing walking pattern can provide immediate and lasting improvements in pain and functional ability² 

Surgery

A: Periacetabular Osteotomy  

For a small group of young adults, with more severe dysplasia and no osteoarthritis, reconstructive surgery may be offered as a treatment. This surgery is called Periacetabular Osteotomy and involves surgical restructuring of the bony hip socket. This is a very large surgery with significant risks and should not be undertaken without good cause. If a surgical path is to be taken, a period of pre-habilitation can help promote a quicker recovery after surgery. Following surgery, there will usually be at least 3-6 months of rehabilitation to recover from the surgery, assist with adjusting to the new bone-muscle relationships and return to everyday and sporting activities.  

B: Hip arthroscopy 

In cases of mild dysplasia, hip arthroscopy is occasionally used to treat joint damage. However, the relative risks and benefits need to be carefully considered as the results are unpredictable and may lead to a worsening of symptoms³. 

How Can You Find a Hip Pain Professional That can Help?

A diagnosis of acetabular dysplasia in the hips is sadly often missed.  If you suspect that you may have this condition, always seek out a health professional with extensive experience and up-to-date knowledge in this area. They will assess your individual specific case and help guide you on the where to and what next. Visit our directory to find a Hip Pain  Professional  near you. 

Our first blog looked at the types of acetabular dysplasia that exist that your Hip Pain  Professional will be assessing for. Our second blog in this series looked at the usual symptoms of hip dysplasia and possible causes of this condition, all questions your Hip Pain  Professional will ask you about.

The focus of this blog has been on treatment for acetabular dysplasia.  This may require a team of Hip Pain  Professionals. to work with you. Conservative options are always exhausted first before other interventions are considered.  But all all times your team will work with you to ensure best outcomes.

References

1. Harris-Hayes, M. and Royer, N. (2011). Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review. PM&R, 3(11), pp.1055-1067.e1. 
2. Lewis, C., Khuu, A. and Marinko, L. (2015). Postural correction reduces hip pain in adult with acetabular dysplasia: A case report. Manual Therapy, 20(3), pp.508-512.
3. Parvizi, J., Bican, O., Bender, B., Mortazavi, S., Purtill, J., Erickson, J. and Peters, C. (2009). Arthroscopy for Labral Tears in Patients with Developmental Dysplasia of the Hip: A Cautionary Note. The Journal of Arthroplasty, 24(6), pp.110-113.

Check Out More You Can Read on this Area at HipPainHelp:

This is the second of a 3 part series of blogs related to acetabular dyslasia about the hips – make sure you follow us over the next few weeks to read our final blog about what treatment options for hip dysplasia are available.

What is Hip Dysplasia: the first of this 3 part blog series discusses what hip dysplasia is and the different types of hip dysplasia that exist.

Usual Symptoms of Acetabular Dysplasia and Possible Causes: in this second of this 3 part hip dysplasia series we look at what symptoms patients may experience if they have dysplasia that was not diagnosed in early childhood.  We also look at the possible causes of hip dysplasia

Hip Pain Explained: This is an encyclopedia of information on the hip and pelvis and all the structures that make up these regions. Many of the possible pathologies  that exist in each area are discussed

Pain Locator Map: you can use this resource by clicking on where you feel your pain.  Information about this area, the structures that exist, and the conditions that may be linked with your pain are all discussed.

Hip Pain Help Blog: click on this and scan through the weekly blogs that have been released by hippainhelp.  If you are looking for hip pain relief ideas, scroll through to find these blogs, which are scattered. throughout the various different specific condition blogs we have written.